Provider Demographics
NPI:1548219686
Name:DULAIGH, JOEL D (NP)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:D
Last Name:DULAIGH
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7600 SAND POINT WAY NE BLDG 8
Mailing Address - Street 2:DIVE MEDICAL OFFICER
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-6349
Mailing Address - Country:US
Mailing Address - Phone:206-526-6474
Mailing Address - Fax:206-526-6506
Practice Address - Street 1:7600 SAND POINT WAY NE BLDG 8
Practice Address - Street 2:DIVE MEDICAL OFFICER
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-6349
Practice Address - Country:US
Practice Address - Phone:206-526-6474
Practice Address - Fax:206-526-6506
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO104321363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO63780721Medicaid
CO63780721Medicaid
COC805378Medicare PIN